15_200_0126_1_3 Assessment Recommendation Therapy or Training - Exercise Physiologist

When to use this code

Use this code for exercise physiology services. An accredited exercise physiologist designs and supervises tailored exercise programs to improve physical function, fitness, and overall health. The $161.99 per hour rate covers the therapist’s direct time plus any clinical notes and reporting completed within the session. Non-face-to-face work like report writing may be billed under the same code if the provider’s agreement allows it.

Common billing scenarios

• A therapist conducts a 1-hour assessment session with a participant. The provider bills 1 hour at $161.99, which covers the face-to-face session time.
• A therapist spends 45 minutes in a face-to-face session and 15 minutes writing clinical notes afterwards. If the service agreement allows non-face-to-face billing, the full hour can be claimed under this code.
• A therapist writes a detailed progress report for a plan review. The report takes 2 hours to complete. This can be billed as non-face-to-face time if the service agreement specifies it and the provider documents the time spent.

Provider notes

• Non-face-to-face delivery is allowed for this code. This means you can bill for activities like report writing, care coordination calls, or progress notes, provided your service agreement with the participant covers these activities. Keep clear records of what non-face-to-face work was done and how long it took.
• This code allows provider travel claims. Travel time to the participant can be billed, but keep in mind the NDIA expects travel to be reasonable. If you are seeing multiple participants in one area, split the travel cost across their plans.
• Short notice cancellation fees apply. If a participant cancels with less than 7 clear days notice (or 2 clear business days for some supports), you can charge up to 100% of the agreed fee. You must document the cancellation and have the cancellation policy in your service agreement.
• Capacity Building funding is time-limited and goal-oriented. Document how the support contributes to the participant’s plan goals, as this will be reviewed at plan reassessment. Unlike Core funding, Capacity Building budgets are usually not flexible across categories.